Can Women Under 40 Get breast cancer?
Breast cancer in women in their twenties and thirties is uncommon, but it does happen. Because no one expects it, it can be missed.
Most breast lumps in young women are not cancer. Many are fibroadenomas, which are solid lumps of normal breast tissue. Many others are cysts, harmless sacs of fluid. Young breasts also change with the monthly cycle and can feel lumpy before a period. That is why a doctor may tell a young woman not to worry.
The truth is that age makes cancer less likely. It does not make it impossible. A doctor’s hands cannot reliably tell a fibroadenoma from cancer. A lump that doesn’t go away needs a test, not just a guess based on age.
So the reasons young women get dismissed are real. Harmless lumps are common, and cancer is rare at this age. But a rare answer still must be ruled out when the signs point to it.
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Article written by Gregory Unatin, Esq. Greg is a managing partner in the law firm of Lupetin & Unatin, a medical malpractice law firm located in Pittsburgh and serving Western Pennsylvania.
Our practice is limited to high-value catastrophic cases because that is where we can do the most for our clients and for patient safety.
The following is a hypothetical situation designed to demonstrate a common form of medical error. It is not a real case, and no physician has reviewed it or offered an opinion about it.
Maria is 31 and lives in Allentown, PA. She finds a lump in her left breast. At her gynecology visit, she mentions that her aunt and grandmother both had breast cancer. The nurse practitioner feels the lump. She says it is likely a fibroadenoma, a common harmless lump. She tells Maria she is too young to worry and to mention it again next year. No imaging is ordered.
Over the next nine months, the lump grows. Maria goes to urgent care, which sends her for an ultrasound, a test that uses sound waves to make a picture. A biopsy, which removes a small piece of tissue for testing, shows breast cancer.
Maria wonders whether her age was used as a reason not to look. This article can help you sort out what careful care looks like for a young woman, and when a delay may support a claim.
What should a doctor do for a young woman with a breast lump?
A young woman with a new lump that stays should have imaging, usually an ultrasound first. Her age changes which test comes first, not whether she gets one.
The American College of Radiology is a national group of imaging doctors. Its 2022 guide on palpable breast masses covers lumps that can be felt. It matches the first test to age:
- Under 30: an ultrasound.
- 30 to 39: an ultrasound or a diagnostic mammogram, which is a detailed mammogram aimed at the problem spot.
If the ultrasound looks suspicious, the next step is a needle biopsy. A thin needle takes a small sample of tissue for testing. The same guide calls for this step.
Some guidelines allow a short wait first. The National Comprehensive Cancer Network is a group of major cancer centers. It allows a recheck after one or two menstrual cycles for women under 30 whose lump seems low risk. That wait should have a set return date and a plan. If the lump is still there, imaging follows. Our article on a breast lump a doctor dismissed as nothing explains the difference between a firm plan and “wait and see.”
Which young women need closer care?
Some young women face a much higher risk of breast cancer and need closer care, even before any lump appears.
The radiology group recommends that every woman have a breast cancer risk assessment by age 25. This 2023 advice means a doctor looks at your history and estimates your chance of breast cancer. The goal is to find women who should start screening early.
These are the main reasons a young woman may be at higher risk:
- A close relative with breast or ovarian cancer, especially at a young age.
- A known gene change, such as BRCA1 or BRCA2, in you or your family.
- Radiation to the chest before age 30, such as treatment for Hodgkin lymphoma, a cancer of the immune system.
For women found to be at high risk, the radiology group recommends screening that starts earlier, often with yearly MRI. An MRI is a scan that uses strong magnets. This is not advice for every young woman. Routine mammograms are not recommended for women at average risk in their twenties and thirties.
Cost may be less of a barrier in Pennsylvania. Act 1 of 2023 covers genetic testing and counseling, and extra screening MRI and ultrasound, for women at higher risk. It applies to state regulated plans, not self insured employer plans or Medicare.
Where does the chance to find breast cancer earlier get missed?
- The lump was dismissed because of age. You were told you were too young, and no imaging was ordered. The chart may say “likely fibroadenoma” with no plan.
- You were told to come back at your next yearly visit. A year is a long time for a lump no one has tested. A recheck within weeks, with imaging if the lump stays, is very different.
- Your family history was not asked about or not acted on. You told the doctor about relatives with breast cancer, but nothing changed. No risk assessment was done, and no genetics referral was made.
- The lump was blamed on pregnancy or breastfeeding. A blocked milk duct is common. But a lump that did not clear was never imaged.
- You came back with the same lump and got the same answer. Each visit leaned on the last one, and no one ordered a test.
What should I check in my own medical records?
You can answer most of these from memory, your patient portal, or your records.
- When did you first report the lump, and to whom?
- Was an ultrasound ordered at that visit?
- If you were told to wait, were you given a date to come back?
- Did anyone ask about breast or ovarian cancer in your family?
- Is your family history written in your chart?
- Were you ever offered genetic counseling or testing?
- How much time passed between your first report and your biopsy?
Did the delay change the outcome?
A missed step alone is not enough for a claim. The question is whether earlier imaging would likely have found the cancer at an earlier, more treatable stage.
That depends on the cancer. Breast cancers grow at different speeds. Some grow slowly over years. Others grow fast. A delay of a few months may matter a great deal for one woman and very little for another.
Lawyers who investigate delayed diagnosis of breast cancer cases and the medical specialists they consult need to answer a few different things. They compare the tumor size when the lump was first reported to its size at diagnosis. They check whether the breast cancer had reached the lymph nodes, the small glands under the arm that filter fluid, or other organs. They look at the type of cancer and how fast that type tends to grow. And they measure the time between the missed chance and the diagnosis.
A delay can also change treatment. A woman who might have needed a small surgery may have needed a mastectomy, which removes the whole breast. Or she may have needed chemotherapy, strong cancer drugs, that might have been avoided.
In Pennsylvania, a family does not always have to prove that an earlier diagnosis would have saved her. It can be enough to show that the delay meaningfully raised the risk of harm. That added risk must also have played a real part in what happened.
When is a missed cancer in a young woman not medical malpractice?
Not every delay is malpractice. A bad outcome does not prove someone made a mistake.
- The right workup was done. You had an ultrasound, and it was read correctly. Some cancers do not show on an ultrasound or mammogram, even when the test is done and read well. A doctor who did the right workup is not at fault just because the cancer was found later.
- A short, planned recheck was followed. You were told to return after your next period. You came back, the lump remained, and you had an ultrasound within weeks.
- The lump that was checked was harmless. A biopsy confirmed a fibroadenoma. The cancer was found later in a different spot.
- The delay likely made no difference. The cancer may have already spread when the lump was first reported. Or the stage would likely have been the same months earlier.
What harms matter in these cases?
Our firm focuses on delays that led to death or catastrophic injury. In breast cancer cases, these are the harms that usually matter:
- Cancer that spread to distant organs, such as the bones, liver, lungs, or brain, before it was found. It can still be treated, but it can no longer be cured.
- Death from a breast cancer that, if found earlier, would likely have been curable.
What to expect when you contact our office
Before we take a case, we review the records and imaging with medical experts. Pennsylvania requires a medical professional’s written statement that a claim has merit before a case can go forward. That review also helps answer whether the delay changed the outcome. A doctor, a nurse practitioner, a practice group, or a hospital system may each have played a role.
Pennsylvania has filing deadlines. For a living patient, the deadline is generally two years from a key date. That is when she knew, or should have known, that she was harmed and that medical care may have caused it. In delayed diagnosis cases, that date is often near the cancer diagnosis. After a death, claims generally must be filed within two years of the date of death. Learn more about how long you have to file a medical malpractice in Pennsylvania. For additional information on breast cancer misdiagnosis, see our main article on delayed diagnosis of breast cancer.
Frequently Asked Questions
Usually, yes. An ultrasound is the usual first test, though a short planned recheck is sometimes reasonable.
No, not at average risk. Women at high risk may start screening earlier, often with MRI.
The American College of Radiology recommends a risk assessment by age 25.
No. Most lumps at this age are harmless, and a claim needs proof that the delay likely changed the outcome or increased the risk of harm.
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Lupetin & Unatin, LLC represents Pennsylvania patients harmed by physicians who failed to meet the standard of care.